Prevalence and factors associated with maternal and neonatal sepsis in sub-Saharan Africa: a systematic review and meta-analysis.

Objectives: This study aimed to determine the prevalence and factors associated with maternal and neonatal sepsis in sub-Saharan Africa. Methods: This systematic review and meta-analysis used the PRISMA guideline on sepsis data in sub-Saharan Africa. The bibliographic search was carried out on the following databases: Medline/PubMed, Cochrane Library, African Index Medicus, and Google Scholar. Additionally, the reference lists of the included studies were screened for potentially relevant studies. The last search was conducted on 15 October 2022. The Joanna Briggs Institute quality assessment checklist was applied for critical appraisal. Estimates of the prevalence of maternal and neonatal sepsis were pooled using a random-effects meta-analysis model. Heterogeneity between studies was estimated using the Q statistic and the I2 statistic. The funnel plot and Egger's regression test were used to assess the publication bias. Results: A total of 39 studies were included in our review: 32 studies on neonatal sepsis and 7 studies on maternal sepsis. The overall pooled prevalence of maternal and neonatal sepsis in Sub-Saharan Africa was 19.21% (95% CI, 11.46-26.97) and 36.02% (CI: 26.68-45.36), respectively. The meta-analyses revealed that Apgar score < 7 (OR: 2.4, 95% CI: 1.6-3.5), meconium in the amniotic fluid (OR: 2.9, 95% CI: 1.8-4.5), prolonged rupture of membranes >12 h (OR: 2.8, 95% CI: 1.9-4.1), male sex (OR: 1.2, 95% CI: 1.1-1.4), intrapartum fever (OR: 2.4, 95% CI: 1.5-3.7), and history of urinary tract infection in the mother (OR: 2.7, 95% CI: 1.4-5.2) are factors associated with neonatal sepsis. Rural residence (OR: 2.3, 95% CI: 1.01-10.9), parity (OR: 0.5, 95% CI: 0.3-0.7), prolonged labor (OR: 3.4, 95% CI: 1.6-6.9), and multiple digital vaginal examinations (OR: 4.4, 95% CI: 1.3-14.3) were significantly associated with maternal sepsis. Conclusion: The prevalence of maternal and neonatal sepsis was high in sub-Saharan Africa. Multiple factors associated with neonatal and maternal sepsis were identified. These factors could help in the prevention and development of strategies to combat maternal and neonatal sepsis. Given the high risk of bias and high heterogeneity, further high-quality research is needed in the sub-Saharan African context, including a meta-analysis of individual data.Systematic review registration: PROSPERO (ID: CRD42022382050).

Progress towards elimination of onchocerciasis transmission in Mali: A "pre-stop MDA" survey in 18 transmission zones.

BACKGROUND: Onchocerciasis control activities in Mali began in 1975 with vector larviciding carried out by the Onchocerciasis Control Programme (OCP), followed by the distribution of ivermectin from 1998 until the closure of the OCP in 2002. At that time, epidemiological evaluations, using skin snip microscopy and O-150 pool screening PCR in black flies, indicated that the disease had been largely controlled as a public health problem. Ivermectin distribution was nevertheless continued after 2002 in 34 of the 75 health districts in Mali as these were known to still be meso- or hyper-endemic for onchocerciasis. In addition, the onchocerciasis sites known to be hypo-endemic for onchocerciasis benefited from the distribution of ivermectin treatment as part of the mass drug administration (MDA) program for lymphatic filariasis. Various entomological and epidemiological evaluations have now indicated that Mali may have achieved successful interruption of onchocerciasis transmission. METHODS: A series of cross-sectional surveys to update vector breeding sites throughout the endemic areas, followed by a pre-stop ivermectin mass drug administration (Pre-stop MDA) survey, were undertaken in 2019-2020. Based on breeding site findings, historical epidemiological assessments, and vector collection site maps, 18 operational transmission zones (OTZ) were delineated within which a total of 104 first line villages were selected for evaluation. Dried blood spots (DBS) samples were collected from 10,400 children (5-9 years old) from these 104 first line villages and processed for the presence of OV16 antibody using a lab-based rapid diagnostic test. RESULTS: Within the 544 Simulium damnosum s.l. breeding sites visited in all five endemic onchocerciasis endemic regions of Mali 18.01% (98/544) were seen to be active with the presence of at least one stage of S. damnosum. The overall prevalence of OV16 positive children was 0.45% (47/10,400). However, two hotspots were identified: 2.60% (13/500) seroprevalence in the OTZ number 5 in Kayes Region and 1.40% (7/500) in the OTZ number 1 of Sikasso Region. CONCLUSION: These data show that onchocerciasis prevalence in the five endemic regions has declined to levels that indicate that Stop-MDA surveys should be now carried out in most of the OTZ except for one in the Kayes Region. This latter site will need additional ivermectin treatment before reevaluation, and an OTZ in the Sikasso Region requires revaluation before possibly reinitiating MDA.

Challenges and difficulties in implementing and adopting isolation and quarantine measures among internally displaced people during the COVID-19 pandemic in Mali (161/250).

Introduction: Isolation and quarantine are among the key measures that protect internally displaced people (IDPs) against COVID-19. This study aims to identify the challenges encountered by humanitarian actors, and health, political, and administrative stakeholders in implementing these measures. It also describes the difficulties faced by IDPs when adopting them, and the local initiatives developed to overcome those difficulties. Method: We conducted a qualitative survey consisting of individual interviews and focus groups among IDPs, humanitarian actors, and health, political, and administrative stakeholders. The data was collected between November and December 2020 in the Bamako and Ségou Regions of Mali. Interviews were recorded with audio recorders, then transcribed and thematically analyzed using the NVivo 13 software. Findings: The study involved 36 individual interviews and eight focus groups with 68 participants of whom IDPs represented 72.3%. The main challenges reported on IDP sites included difficulties in contacting positive cases, a lack of facilities for quarantine and isolation, a lack of physical space for building new facilities, and a lack of financial resources to support IDPs during isolation and quarantine. The difficulties reported included: changes in social behavior and practices, fear of stigma, a poor level of literacy, and language barriers. To address those difficulties, the local initiatives developed by IDPs included strengthening the awareness of IDPs on COVID-19, early warning of sites' leaders about positive and suspected cases, and setting up a toll-free number to facilitate access to appropriate information on COVID-19. Conclusion: The findings of this study could be used as evidence to guide policy, adjust current strategies and take into account with more focus IDPs, a group with increased vulnerability, in COVID-19 response, more precisely during the implementation of isolation and quarantine measures. By doing so, they will help improve the response to COVID-19, IDPs health, and population health.

Prevalence and Risk Factors Associated with Epilepsy in Six Health Districts of Mali: A Community-Based Cross-Sectional and Nested Case-Control Study.

INTRODUCTION: In resource-limited countries, epilepsy prevalence is underestimated and little is known about its risk factors. OBJECTIVES: This study aimed to determine the prevalence and risk factors for epilepsy in six health districts (HDs) in Mali. METHODS: A community-based cross-sectional and nested case-control study was conducted in 180 villages with the highest number of suspicious epilepsy cases (SECs) in the six study HDs. The SECs were observed as part of a Phase 1 screening conducted by community health workers. For the nested case-control study, one case was matched with at least one control based on residence and age. A case of epilepsy was a person diagnosed with convulsive epilepsy after clinical assessment by a neurologist. A control was a person diagnosed as normal after neurological assessment by a neurologist. Data were collected on sociodemographic characteristics, familial and medical history of epilepsy, consanguinity, place of delivery, preterm birth, length/type of delivery, and history of meningitis and cerebral malaria. A univariate and multivariate binomial logistic regression model was used to analyse factors associated with epilepsy. RESULTS: A total of 1,506 cases of epilepsy and 2,199 controls were enrolled in six HDs. The mean prevalence of epilepsy was 2‰, with the highest in Kenieba (3‰), a previously meso-endemic-onchocerciasis HD, and the lowest in Kadiolo (1.5‰), a hypo-endemic-onchocerciasis HD. Age (adjusted odds ratio [aOR] = 1.02 [95% confidence intervals [CI] 1.02-1.03]), history of cerebral malaria (aOR = 11.41 [95% CI 8.86-14.85]), history of meningitis (aOR = 1.95 [95% CI 1.16-3.29]), living in the HD of Tominian (aOR = 1.69 [95% CI 1.29-2.22]), delayed delivery (aOR = 3.21 [95% CI 2.07-5.07]), and dystocia (aOR = 3.37 [95% CI 2.03-5.73]) were all significantly associated with epilepsy. CONCLUSION: The prevalence of epilepsy (3‰) in a previously meso-endemic-onchocerciasis HD was much lower than the prevalence (13.35‰) documented in onchocerciasis endemic areas in 2,000. This decrease epilepsy prevalence in the previously meso-endemic region was induced by onchocerciasis, and the reduction was due to an effective community direct treatment with ivermectin programme. Cerebral malaria and obstetrical complications were the main risk factors for epilepsy and interventions improving malaria prevention/treatment and optimizing prenatal and obstetrical care need to be implemented to reduce incidence.

Hygiène bucco-dentaire des militaires des unités d'élites des forces de défense et de sécurité du Mali / Oral hygiene of the military of the elite units of the defense and security forces of Mali

Introduction: L'hygiène orale représente l'ensemble des mesures prises pour garder la cavité́ orale propre et saine en maintenant les surfaces dentaires dépourvues de plaque et de tartre. L'objectif de cette étude était d'évaluer l'hygiène buccodentaire des Unités d'Élites des forces de défense et de sécurité du Mali. Méthodologie : Il s'agissait d'une étude transversale descriptive qui s'est déroulée du 01 Septembre 2020 au 30 Aout 2021 dans le service d'Odontologie de l'Infirmerie Hôpital de Bamako (IHB). La population d'étude était constituée de militaires en service dans les différentes Unités d'Élites des corps d'Armée du Mali venus en consultation dans le service d'Odontologie et par d'autres Unités dans leur Quartier Général (QG) compte tenu de leur confidentialité. Résultats : Dans cette étude, la tranche d'âge 30 ­ 39 ans était la plus représentée avec 49,2%. Les sous-officiers étaient les plus représentés avec 55,0%. Parmi les Unités d'Élites, la CIR représentait 34,8%. Pour le brossage des dents, 85,9% se brossaient les dents. Par rapport au nombre de brossage par jour, 54,7% se brossaient les dents 1 fois par jour. Tandis que 48,1% se brossaient les dents avec une brosse de type Medium. Pour le saignement après le brossage, 42,6% avaient un saignement après le brossage. Conclusion: Cette étude a montré que les militaires avaient une connaissance sur l'hygiène buccodentaire car ils se brossaient majoritairement 1 à 2 fois par jour. Toutefois, beaucoup de militaires présentaient un saignement après brossage. Devant cette situation, une nouvelle orientation de la politique de santé bucco-dentaire basée sur l'odontologie préventive s'impose afin d'améliorer la santé et la qualité́ de vie de ces militaires

Introduction: Oral hygiene represents all the measures taken to keep the oral cavity clean and healthy by keeping the dental surfaces free of plaque and tartar. The objective of this study was to evaluate the oral hygiene of elite units of the defense and security forces of Mali. Methodology: This was a descriptive cross-sectional study that took place from September 01, 2020, to August 30, 2021, in the odontology department of Bamako Military Hospital. The study population involved soldiers of various Elite Units of the Armed Forces of Mali who came for consultation in the odontology service. Results: In this study, the 30-39 age group was the most represented with 49.2%. NCOs were the most represented with 55.0%. Among Elite Units, the CIR accounted for 34.8%. For tooth brushing, 85.9% brushed their teeth. Regarding the number of brushings per day, 54.7% brushed their teeth once a day. While 48.1% brushed their teeth with a medium brush. For bleeding after brushing, 42.6% had bleeding after brushing. Conclusion: This study showed that the military had knowledge of oral hygiene because they brushed mostly 1 to 2 times a day. However, many soldiers had bleeding after brushing. Faced with this situation, a new orientation of the oral health policy based on preventive odontology is necessary in order to improve the health and quality of life of these soldiers

Relation entre exposition professionnelle des manipulateurs de déchets d'équipements électriques et électroniques et problèmes respiratoires à Bamako en 2019 / Relationship between occupational exposure of waste electrical and electronic equipment handlers and respiratory problems in Bamako in 2019

Introduction: les déchets d'équipements électriques et électroniques (D3E), avec leurs enjeux sanitaires et environnementaux, sont devenus un problème de santé publique exposant les travailleurs aux composés d'éléments toxiques responsables de (2ème expertise) troubles respiratoires. Objectif: Etudier la relation entre l'exposition professionnelle aux D3E et la survenue des problèmes respiratoires à Bamako en 2019. Matériel et Méthodes : Il s'agissait d'une étude transversale, analytique de 6 mois, menée dans la ville de Bamako en 2019 et concernait 159 manipulateurs de D3E. Les données ont été collectées sur tablette et les analyses univariées et multivariées réalisées sur SPSS version 22 au seuil de significativité de 0,05 avec présentation des Odds Ratio (OR) et leurs intervalles de confiance à 95% (OR[IC95%]). Résultats : La prévalence en général des troubles respiratoires était de 67,3% chez les manipulateurs des D3E. On notait que le retrait du revêtement des fils électroniques (OR[IC95%] =25,93[2,30;291,53]), la perte de poids récente en dehors d'un régime (OR[IC95%] =7,43[1,68;32,85]) et la rareté de lavage des mains avec du savon après les toilettes (OR[IC95%] =11,50[2,07;63,89]) représentaient un risque plus élevé de problèmes respiratoires. Conclusion :Ces résultats montrent que les manipulateurs de D3E ont beaucoup de comportement à risque des problèmes respiratoires. Cette étude pourrait servir à la mise en œuvre de stratégies visant à réduire l'impact des D3E

Introduction: waste electrical and electronic equipment (WEEE), with its health and environmental issues, has become a public health problem exposing workers to toxic compounds causing respiratory problems. Objective: To study the relationship between professional exposure to WEEE and the occurrence of respiratory problems in Bamako in 2019. Material and Methods: This was a 6-month cross-sectional, analytical study carried out in the city of Bamako in 2019 and involved 159 WEEE manipulators. Data were collected using a tablet (2). Univariate and multivariate analyzes were performed using SPSS version 22 with the significance level of 0.05. Odds Ratio (OR) were presented with their 95% confident interval (OR [95%CI]). Results: The overall prevalence of respiratory disorders was 67.3% among WEEE handlers. It was noted that the removal of the coating of electronic wires (OR [95%CI] =25.93[2.30;291.53]), recent weight loss outside of a diet (OR [95% CI] =7,43[1.68;32.85]) and the infrequent hand washing with soap after the toilet (OR [95% CI] =11.50[2.07; 63.89]) represented a higher risk of (2) breathing problems. Conclusion: These results show that D3E handlers have a lot of risky behavior for respiratory problems. This study could be used to implement strategies to reduce the impact of D3E

Information about COVID-19: Lessons learned from Mali

Introduction. In Mali, information related to COVID-19 is regularly shared by the coordination board against COVID-19 through daily official press releases and situation reports. The goal of this study was to analyze data related to the tested samples; and the confirmed, contacts, recovered and dead cases in order to take lessons for the future. Population and methods. Data from the first 100 days after the detection of the first cases in Mali were collected and recorded on an Excel file before they got analyzed using SPSS 25.0 software. Analyses were descriptive and correlational. Results. We included 14938 tested samples, 2260 confirmed cases, 12864 contact cases, 1502 recovered cases and 117 deaths were reported during the first 100 days of the epidemic. There was a positive correlation between the number of confirmed cases; and the number of tested samples, the number of recovered cases and the number of deaths. These results suggest that the number of confirmed cases increase with the number of tested samples. Conclusion. These results call for more testing and encourage the identification, location and follow-up of COVID-19 cases. They can also be used to support the improvement of data quality and the response to COVID-19. As a result, they can contribute to improve population health

[Relationship between occupational exposure of waste manipulators of electrical and electronic equipment and respiratory problems in Bamako in 2019]. / Relation entre exposition professionnelle des manipulateurs de dechets d'equipements electriques et electroniques et problemes respiratoires a Bamako en 2019.

INTRODUCTION: waste electrical and electronic equipment (WEEE), with its health and environmental issues, has become a public health problem exposing workers to toxic compounds causing respiratory problems. OBJECTIVE: To study the relationship between professional exposure to WEEE and the occurrence of respiratory problems in Bamako in 2019. MATERIAL AND METHODS: This was a 6-month cross-sectional, analytical study carried out in the city of Bamako in 2019 and involved 159 WEEE manipulators. Data were collected using a tablet (2). Univariate and multivariate analyzes were performed using SPSS version 22 with the significance level of 0.05. Odds Ratio (OR) were presented with their 95% confident interval (OR[95%CI]). RESULTS: The overall prevalence of respiratory disorders was 67.3% among WEEE handlers. It was noted that the removal of the coating of electronic wires (OR[95%CI]=25.93[2.30;291.53]), recent weight loss outside of a diet (OR[95% CI]=7,43[1.68;32.85]) and the infrequent hand washing with soap after the toilet (OR[95% CI]=11.50[2.07; 63.89]) represented a higher risk of (2) breathing problems. CONCLUSION: These results show that D3E handlers have a lot of risky behavior for respiratory problems. This study could be used to implement strategies to reduce the impact of D3E.

INTRODUCTION: les déchets d'équipements électriques et électroniques (D3E), avec leurs enjeux sanitaires et environnementaux, sont devenus un problème de santé publique exposant les travailleurs aux composés d'éléments toxiques responsables de (2ème expertise) troubles respiratoires. OBJECTIF: Etudier la relation entre l'exposition professionnelle aux D3E et la survenue des problèmes respiratoires à Bamako en 2019. MATÉRIEL ET MÉTHODES: Il s'agissait d'une étude transversale, analytique de 6 mois, menée dans la ville de Bamako en 2019 et concernait 159 manipulateurs de D3E. Les données ont été collectées sur tablette et les analyses univariées et multivariées réalisées sur SPSS version 22 au seuil de significativité de 0,05 avec présentation des Odds Ratio (OR) et leurs intervalles de confiance à 95% (OR[IC95%]). RÉSULTATS: La prévalence en général des troubles respiratoires était de 67,3% chez les manipulateurs des D3E. On notait que le retrait du revêtement des fils électroniques (OR[IC95%]=25,93[2,30;291,53]), la perte de poids récente en dehors d'un régime (OR[IC95%]=7,43[1,68;32,85]) et la rareté de lavage des mains avec du savon après les toilettes (OR[IC95%]=11,50[2,07;63,89]) représentaient un risque plus élevé de problèmes respiratoires. CONCLUSION: Ces résultats montrent que les manipulateurs de D3E ont beaucoup de comportement à risque des problèmes respiratoires. Cette étude pourrait servir à la mise en œuvre de stratégies visant à réduire l'impact des D3E.

[Oral hygiene of the military of the elite units of the defense and security forces of Mali]. / Hygiene bucco-dentaire des militaires des unites d'elites des forces de defense et de securite du Mali.

INTRODUCTION: Oral hygiene represents all the measures taken to keep the oral cavity clean and healthy by keeping the dental surfaces free of plaque and tartar. The objective of this study was to evaluate the oral hygiene of elite units of the defense and security forces of Mali. METHODOLOGY: This was a descriptive cross-sectional study that took place from September 01, 2020 to August 30, 2021 in the odontology department of Bamako Military Hospital. The study population involved soldiers of various Elite Units of the Armed Forces of Mali who came for consultation in the odontology service. RESULTS: In this study, the 30-39 age group was the most represented with 49.2%. NCOs were the most represented with 55.0%. Among Elite Units, the CIR accounted for 34.8%. For tooth brushing, 85.9% brushed their teeth. Regarding the number of brushings per day, 54.7% brushed their teeth once a day. While 48.1% brushed their teeth with a medium brush. For bleeding after brushing, 42.6% had bleeding after brushing. CONCLUSION: This study showed that the military had knowledge of oral hygiene because they brushed mostly 1 to 2 times a day. However, many soldiers had bleeding after brushing. Faced with this situation, a new orientation of the oral health policy based on preventive odontology is necessary in order to improve the health and quality of life of these soldiers.

INTRODUCTION: L'hygiène orale représente l'ensemble des mesures prises pour garder la cavité́ orale propre et saine en maintenant les surfaces dentaires dépourvues de plaque et de tartre. L'objectif de cette étude était d'évaluer l'hygiène buccodentaire des Unités d'Élites des forces de défense et de sécurité du Mali. MÉTHODOLOGIE: Il s'agissait d'une étude transversale descriptive qui s'est déroulée du 01 Septembre 2020 au 30 Aout 2021 dans le service d'Odontologie de l'Infirmerie Hôpital de Bamako (IHB). La population d'étude était constituée de militaires en service dans les différentes Unités d'Élites des corps d'Armée du Mali venus en consultation dans le service d'Odontologie et par d'autres Unités dans leur Quartier Général (QG) compte tenu de leur confidentialité. RÉSULTATS: Dans cette étude, la tranche d'âge 30 ­ 39 ans était la plus représentée avec 49,2%. Les sous-officiers étaient les plus représentés avec 55,0%. Parmi les Unités d'Élites, la CIR représentait 34,8%. Pour le brossage des dents, 85,9% se brossaient les dents. Par rapport au nombre de brossage par jour, 54,7% se brossaient les dents 1 fois par jour. Tandis que 48,1% se brossaient les dents avec une brosse de type Medium. Pour le saignement après le brossage, 42,6% avaient un saignement après le brossage. CONCLUSION: Cette étude a montré que les militaires avaient une connaissance sur l'hygiène buccodentaire car ils se brossaient majoritairement 1 à 2 fois par jour. Toutefois, beaucoup de militaires présentaient un saignement après brossage. Devant cette situation, une nouvelle orientation de la politique de santé bucco-dentaire basée sur l'odontologie préventive s'impose afin d'améliorer la santé et la qualité de vie de ces militaires.

Can We Use Routine Data for Strategic Decision Making? A Time Trend Comparison Between Survey and Routine Data in Mali.

BACKGROUND: Countries with scarce resources need timely and high-quality data on coverage of health interventions to make strategic decisions about where to allocate investments in health. Household survey data are generally regarded as "gold standard," high-quality data. This study assessed the comparability of intervention coverage time trends from routine and survey data at national and subnational levels in Mali. METHODS: We compared 3 coverage indicators: contraceptive prevalence rate, institutional delivery, and 3 doses of diphtheria, pertussis, and tetanus (DPT3) vaccine, using 3 Mali Demographic and Health Surveys (DHS 2001, 2006, and 2012-2013) and routine health system data covering 2001-2012. For routine data, we used local health information system (HIS) annual reports and an HIS database. To compare time trends between the data sources, we calculated the percentage point change and 95% confidence interval from 2001-2006 and 2006-2012. We then computed the absolute and relative differences between the 2 data sources for each indicator over time at national and regional levels and assessed their level of significance. RESULTS: The direction and magnitude of the time trends of contraceptive prevalence rate, institutional delivery, and DPT3 vaccine from 2001 to 2012 were similar at the national level between data sources. At the regional level, there were significant differences in the magnitude and direction of time trends for institutional delivery and the DPT3 vaccine; contraceptive prevalence trends were more consistent. Routine data tended to overestimate DPT3 coverage, and underestimate institutional delivery and contraceptive prevalence relative to survey data. CONCLUSION: Routine data in Mali-particularly at the national level-appear to be appropriate for use to inform program planning and prioritization, but routine time trends should be interpreted with caution at the subnational level. For program evaluations, routine data may not be appropriate to draw accurate inferences about program impact.

[Factors associated to the implementation of compulsory health insurance at the CHC level in Kalaban Coro, Kati, Mali]. / Lies a la mise en œuvre de l'assurance maladie obligatoire au niveau des cscoms a Kalaban Coro, Kati, Mali.

OBJECTIVE: To identify the factors influencing the implementation of compulsory health insurance in two community health centers (CHC) in the health district of Kalaban Coro in Kati. MATERIAL METHODS: It was a cross-sectional descriptive study from July 1, 2017 to October 31, 2018 in both CHC of Koulouba and Kalaban Coro central. We conducted a literature review and in-depth interviews with 20 people. A content analysis was done manually using deductive and inductive logic. RESULTS: Out of all the services in 2017, those insured by the compulsory health insurance benefited from 5% of deliveries, 7% of the first antenatal cares and 8% of curative cares at the CHC of Koulouba against 0.1%, 0,3% and 3% respectively in CHC of Kalaban Coro central. The implementation of the compulsory health insurance and the reimbursement mechanisms have been facilitated through the establishment of information and communication channels, the training of members of the Federations of Community Health Associations at national, regional and local levels and other forms of support for CHC. The reimbursement period was 1-3 months in Koulouba against an absence since 2017 in Kalaban Coro central. Governance, monitoring and evaluation and staff motivation systems were weak or nonexistent. They resulted in financial and drug supply difficulties. CONCLUSION: Among the factors identified, the reimbursement mechanism posed the most problem for CHC and delegated management organizations.

OBJECTIF: Identifier les facteurs influençant la mise en œuvre de l'assurance maladie obligatoire dans deux centres de santé communautaire du district sanitaire de Kalaban Coro dans le Cercle de Kati. MATÉRIEL MÉTHODES: il s'agissait d'une étude transversale descriptive couvrant la période du 1er juillet 2017 au 31 octobre 2018 dans les CSComs de Koulouba et Kalaban Coro central. Nous avons réalisé une analyse documentaire et des entrevues individuelles approfondies de 20 personnes. Une analyse de contenu a été faite manuellement selon les logiques déductive et inductive. RÉSULTATS: Sur l'ensemble des prestations en 2017, les assurés de l'AMO ont bénéficié de 5% des accouchements, 7% des premières consultations prénatales et 8% des consultations curatives au niveau du CSCom de Koulouba contre respectivement 0,1%, 0,3% et 3% à Kalaban Coro central. La mise en œuvre de l'AMO et les mécanismes de remboursement ont été facilités grâce à la mise en place des canaux d'informations et de communications, à la formation des membres des Fédérations des ASACO au niveau national, régional et local et à d'autres formes d'appuis aux CSComs. Le délai de remboursement était de 1-3mois à Koulouba contre une absence depuis 2017 à Kalaban Coro central. Les systèmes de gouvernance, de suivi et évaluation et de motivations du personnel étaient insuffisants, voire inexistant. Ils avaient pour conséquences, des difficultés financières et d'approvisionnement en médicaments. CONCLUSION: Parmi les facteurs identifiés, le mécanisme de remboursement des prestations posait le plus de problème aux CSComs et organismes gestionnaires délégués.

Surveillance des paralysies flasques aiguës en Côte d'Ivoire de 2007 à 2016 : importance et profil épidémiologique des entérovirus non poliovirus.

INTRODUCTION: Côte d'Ivoire's status as a polio-free country requires high quality surveillance of acute flaccid paralysis. Our study aims to determine the prevalence of non-poliovirus enteroviruses found in the surveillance of Acute Flaccid Paralysis (AFP) in Côte d'Ivoire and to study their distribution according to individual characteristics and associated factors. METHOD: We conducted an exhaustive descriptive and analytical cross-sectional retrospective study on 3597 cases of acute flaccid paralysis notified in the context of surveillance of AFP from 2007 to 2016 in Côte d'Ivoire. RESULTS: The mean annual rate of non-poliovirus enterovirus over the period was 11.3% over the study period with extremes of 9.2% and 15.9%. The absence of fever at the onset of illness and early age were factors associated with the occurrence of acute flaccid paralysis due to non-poliovirus enterovirus. CONCLUSION: Our study found a downward trend in non-poliovirus enteroviruses detected in AFP surveillance in Côte d'Ivoire, and identified the absence of fever and the age of the subject as being the factors associated with their occurrence. It is therefore necessary to type all cases of non-poliovirus enteroviruses detected in AFP surveillance to assess the risks of vaccine-derived polioviruses.

[Determinants of home delivery in two neighborhoods in Commune V of Bamako]. / Comparaison des determinants de l'accouchement a domicile dans deux quartiers en Commune V de Bamako.

OBJECTIVE: The objective was to study the determinants of home delivery in the Commune V Health District of Bamako. MATERIALS AND METHODS: We conducted an analytical cross-sectional study among women who delivered at home, in two neighborhoodsofSabalibougou and Badalabougou, from March 2015 to February 2016, and who were admitted at the Maternity of the Commune V Referral Health Center during the same period. Two groups of women from two neighborhoods were compared. The data were entered and analyzed using EpiInfo 3.5.3. We presented the Odds Ratios and confident intervals. RESULTS: The frequency of home delivery was 16.18%. The age group 35 years and over were the most represented in both Sabalibougou with 80.75% and Badalabougou with 19.42%.In Sabalibougou, compared to Badalabougou, we found 0.49 times fewer women in school (p = 0.01); 8.92 times more women with gainful occupation (p = 10-8); 3.5 times more partners with non-gainful occupation (p = 10-6); 4.59 times more risk to give birth at home (p = 10-8); 3 times more risk not to perform antenatal care (p = 0.0002); 3.26 times more appreciation of the high cost of delivery care (p = 10-4) and 3.03 times more lack of financial support (p=3*10-4). CONCLUSION: The frequency of home delivery was higher in Sabalibougou. The determinants of this phenomenon were: the low level of schooling, the low socioeconomic level, the non-use of antenatal care, theperceived high cost of delivery care.

OBJECTIF: L'objectif était d'étudierles déterminants de l'accouchement à domicile en Commune V de Bamako. MATÉRIELS ET MÉTHODES: Nous avons mené une étude transversale analytique chez les femmes qui ont accouchées à domicile, dans les quartiers de Sabalibougou et Badalabougou, de Mars 2015 en Février 2016 et reçues à la maternité du Centre de Santé de Référence de la Commune V pendant la même période. Les deux quartiers ont été comparés. Les données ont été saisies et analysées sur EpiInfo 3.5.3, avec présentation des Odds Ratios et intervalles de confiance. RÉSULTATS: La fréquence de l'accouchement à domicile était de 16,18%.La tranche d'âge 35 ans et plus était la plus représentée à Sabalibougou (80,75%) et à Badalabougou (19,42%). Nous avons trouvéà Sabalibougou, comparé à Badalabougou, 0,49 fois moins de femmes scolarisées (p=0,01) ;8,92 fois plus de femmes avec activité rémunératrice (p=10-8) ;3,5 fois plus de partenaires avec activité non rémunératrice (p=10-6) ; 4,59 fois plus de risque d'accoucher à domicile (p=10-8) ; 3 fois plus de risque de ne pas réaliser de consultation prénatale (p=0,0002) ;3,26 fois plus d'appréciation du coût de l'accouchement élevé (p=10-4) et3,03 fois plus de manque de moyens (p=3*10-4). CONCLUSION: La fréquence de l'accouchement à domicile était plus élevée à Sabalibougou.Les déterminants étaient : l'absence de scolarisation, lemanque de moyens financiers, l'absence de réalisation de consultation prénatale, le coût jugé élevé de l'accouchement.

[Factors associated to the cessation of exclusive breastfeeding in rural and urban areas in Mali] / Facteurs associés à la cessation de l'allaitement maternel exclusif en milieux rural et urbain au Mali.

INTRODUCTION: The study had for object to identify factors associated to the cessation of the exclusive breast-feeding at the mothers of children from 0 to 6 months in the urban and rural circles in Mali. METHOD: The study was longitudinal forward-looking, realized in Bamako (urban area) and in Dialakoroba (rural area) from April till November, 2016. in total, 218 mothers were enlisted (114 by area) in a voluntary way in health centers. A monthly follow-up of six months was realized in the place of residence. The SPSS 20 software was used for the seizure and the data analysis. The expected event was to give to the child another food than maternal milk. Test statistics such as Chi2 of Log Rank and Hazard Ratio (HR) were used with threshold of meaning p ≤ 0,05. RESULTS: In urban zones and rural respectively 68,5 % and 71,5% of the mothers had stopped the Exclusive Breast-feeding (EBF) before six months. Factors associated to this cessation of the EBF were: the use of the feeding-bottle (HR=2,61; IC 95%: [1,46-4,48]), the care of the child during less than three months as main occupation (HR=3,18; IC 95%: [1,95-5,20]), the support for the mother during less than three months (HR=3,79; IC 95%: [2,31-6,22]), the advice(council) on the EBF (HR=0,64; IC 95%: [0,46-0,98]) and the experience (experiment) of breastfeeding (HR=0,34; IC 95%: [0,15-0,84]). CONCLUSION: The consideration of the identified factors(mailmen) will allow to improve the practice of the EBF in six months in the sites of the study.

[Surveillance of acute flaccid paralysis in Ivory Coast between 2007 and 2016: Significance and epidemiological profile of non-poliovirus enteroviruses]. / Surveillance des paralysies flasques aiguës en Côte d'Ivoire de 2007 à 2016 : importance et profil épidémiologique des entérovirus non poliovirus.

INTRODUCTION: Côte d'Ivoire's status as a polio-free country requires high quality surveillance of acute flaccid paralysis. Our study aims to determine the prevalence of non-poliovirus enteroviruses found in the surveillance of Acute Flaccid Paralysis (AFP) in Côte d'Ivoire and to study their distribution according to individual characteristics and associated factors. METHOD: We conducted an exhaustive descriptive and analytical cross-sectional retrospective study on 3597 cases of acute flaccid paralysis notified in the context of surveillance of AFP from 2007 to 2016 in Côte d'Ivoire. RESULTS: The mean annual rate of non-poliovirus enterovirus over the period was 11.3% over the study period with extremes of 9.2% and 15.9%. The absence of fever at the onset of illness and early age were factors associated with the occurrence of acute flaccid paralysis due to non-poliovirus enterovirus. CONCLUSION: Our study found a downward trend in non-poliovirus enteroviruses detected in AFP surveillance in Côte d'Ivoire, and identified the absence of fever and the age of the subject as being the factors associated with their occurrence. It is therefore necessary to type all cases of non-poliovirus enteroviruses detected in AFP surveillance to assess the risks of vaccine-derived polioviruses.

Using the Lives Saved Tool to aid country planning in meeting mortality targets: a case study from Mali.

BACKGROUND: Mali is one of four countries implementing a National Evaluation Platform (NEP) to build local capacity to answer evaluation questions for maternal, newborn, child health and nutrition (MNCH&N). In 2014-15, NEP-Mali addressed questions about the potential impact of Mali's MNCH&N plans and strategies, and identified priority interventions to achieve targeted mortality reductions. METHODS: The NEP-Mali team modeled the potential impact of three intervention packages in the Lives Saved Tool (LiST) from 2014 to 2023. One projection included the interventions and targets from Mali's ten-year health strategy (PDDSS) for 2014-2023, and two others modeled intervention packages that included scale up of antenatal, intrapartum, and curative interventions, as well as reductions in stunting and wasting. We modeled the change in maternal, newborn and under-five mortality rates under these three projections, as well as the number of lives saved, overall and by intervention. RESULTS: If Mali were to achieve the MNCH&N coverage targets from its health strategy, under-5 mortality would be reduced from 121 per 1000 live births to 93 per 1000, far from the target of 69 deaths per 1000. Projections 1 and 2 produced estimated mortality reductions from 121 deaths per 1000 to 70 and 68 deaths per 1000, respectively. With respect to neonatal mortality, the mortality rate would be reduced from 39 to 32 deaths per 1000 live births under the current health strategy, and to 25 per 1000 under projections 1 and 2. CONCLUSIONS: This study revealed that achieving the coverage targets for the MNCH&N interventions in the 2014-23 PDDSS would likely not allow Mali to achieve its mortality targets. The NEP-Mali team was able to identify two packages of MNCH&N interventions (and targets) that achieved under-5 and neonatal mortality rates at, or very near, the PDDSS targets. The Malian Ministry of Health and Public Hygiene is using these results to revise its plans and strategies.

[Tetanus vaccination of women of childbearing age in Bamako (Mali)]. / Vaccination antitetanique des femmes en age de procreer a Bamako au Mali.

In Mali, despite the existence of a national vaccination policy, coverage of neonatal tetanus remains low. According to the Demographic and Health Survey (DHS) IV Mali, the rate of births protected against neonatal tetanus is 56%.The objective of this study was to investigate the status of tetanus toxoid (TT) in women of reproductive age (WRA) in the municipality V of Bamako District.The study was conducted in Mali in the municipality V of the Bamako District. This was a cross-sectional study conducted from July to October 2006. The target population was composed of women of reproductive age and health care providers. A total of 262 people, including 200 women of childbearing age and 62 health care providers were interviewed.The age group 14-23 years accounted for 39% of WRA. Among the WRA, 27.4% did not know that tetanus vaccination is to prevent maternal and neonatal tetanus. Most of WRA, or 61.8%, thought that a single dose of TT was enough to be protected. Among WRA surveyed, 76.2% were vaccinated where 66.7% had received between 2 and 10 doses of TT. Women who received no dose of TT were nulliparous and primiparous. The main reasons given by women who had not received vaccination were lack of knowledge (47.6%), lack of time (14.3%) and neglect (23.8%). The health personnel interviewed spoke of running out of TT stocks less than a week after receiving new orders, in 7/11 health centers. Strengthening Behaviour Change Communication (BCC) for tetanus vaccination and immunization schedule compliance will increase tetanus vaccination coverage. To avoid stockouts, we recommend a regular and sufficient reorder of TT in health centers.

Au Mali malgré l'existence d'une politique nationale de vaccination, la couverture vaccinale du tétanos néonatal reste faible .Selon l'Enquête Démographique et de Santé (EDS) IV du Mali, le taux de naissances protégées contre le tétanos néonatal est de 56 %. L'objectif de cette étude était d'étudier l'état de la vaccination antitétanique (VAT) chez les femmes en âge de procréer (FAP) de la commune V du District de Bamako.L'étude a été menée au Mali dans la commune V du District de Bamako. C'était une étude de type transversal réalisée de juillet à octobre 2006. La population cible était composée de femmes en âge de procréer et de prestataires de santé. Au total, 262 personnes dont 200 femmes en âge de procréer et 62 prestataires de santé ont été interrogées.La tranche d'âge 14­23 ans représentait 39 % des FAP. Parmi les FAP interrogées, 27,4 % ne savaient pas que la vaccination antitétanique a pour but d'éviter le tétanos maternel et néonatal La majorité des FAP soient 61,8 % pensaient qu'une seule dose de VAT suffisait pour être protégée. Parmi les FAP enquêtées, 76,2 % ont été vaccinées dont 66,7 % avaient reçu entre 2 et 10 doses de VAT. Les femmes n'ayant reçu aucune dose de VAT étaient les nullipares et les primipares. Les principales raisons évoquées par les femmes qui n'avaient pas reçu de doses de vaccin étaient la méconnaissance (47,6 %), le manque de temps (14,3 %) et la négligence (23,8 %).Le personnel de santé interrogé a évoqué des ruptures en VAT de moins d'une semaine, dans 7 /11 centres de santé. Le renforcement de la communication pour le changement de comportement (CCC) pour la vaccination antitétanique et le respect du calendrier vaccinal permettront d'augmenter la couverture vaccinale antitétanique. Pour éviter les ruptures de stocks, nous recommandons une dotation régulière et suffisante des centres de santé en vaccin antitétanique.

Vaccination antitetanique des femmes en age de procreer a Bamako au Mali

Au Mali malgre l'existence d'une politique nationale de vaccination; la couverture vaccinale du tetanos neonatal reste faible .Selon l'Enquete Demographique et de Sante (EDS) IV du Mali; le taux de naissances protegees contre le tetanos neonatal est de 56 %. L'objectif de cette etude etait d'etudier l'etat de la vaccination antitetanique (VAT) chez les femmes en age de procreer (FAP) de la commune V du District de Bamako. L'etude a ete menee au Mali dans la commune V du District de Bamako. C'etait une etude de type transversal realisee de juillet a octobre 2006. La population cible etait composee de femmes en age de procreer et de prestataires de sante. Au total; 262 personnes dont 200 femmes en age de procreer et 62 prestataires de sante ont ete interrogees. La tranche d'age 14 23 ans representait 39 % des FAP. Parmi les FAP interrogees; 27;4 % ne savaient pas que la vaccination antitetanique a pour but d'eviter le tetanos maternel et neonatal La majorite des FAP soient 61;8 % pensaient qu'une seule dose de VAT suffisait pour etre protegee. Parmi les FAP enquetees; 76;2 % ont ete vaccinees dont 66;7 % avaient recu entre 2 et 10 doses de VAT. Les femmes n'ayant recu aucune dose de VAT etaient les nullipares et les primipares. Les principales raisons evoquees par les femmes qui n'avaient pas recu de doses de vaccin etaient la meconnaissance (47;6 %); le manque de temps (14;3 %) et la negligence (23;8 %).Le personnel de sante interroge a evoque des ruptures en VAT de moins d'une semaine; dans 7 /11 centres de sante. Le renforcement de la communication pour le changement de comportement (CCC) pour la vaccination antitetanique et le respect du calendrier vaccinal permettront d'augmenter la couverture vaccinale antitetanique. Pour eviter les ruptures de stocks; nous recommandons une dotation reguliere et suffisante des centres de sante en vaccin antitetanique

Strengthening Community Networks for Vital Event Reporting: Community-Based Reporting of Vital Events in Rural Mali.

BACKGROUND: Like many developing countries, Mali has few sources of mortality data. High quality mortality estimates are available from household surveys, such as the demographic and health surveys (DHS), approximately every five years, making it difficult to track progress in reducing mortality. The Rapid Mortality Monitoring (RMM) project in Mali aimed to address this issue by testing a community-based approach to measuring under-five mortality on a yearly basis. METHODS AND FINDINGS: Seventy-eight community-based workers (relais) were identified in 20 villages comprising approximately 5,300 households. The relais reported pregnancies, births, and under-five deaths from July, 2012 to November, 2013. Data were double-entered, reconciled, cleaned, and analyzed monthly. In November-December 2013, we administered a full pregnancy history (FPH) to women of reproductive age in a census of the households in the project villages. We assessed the completeness of the counts of births and deaths, and the validity of under-five, infant, and neonatal mortality rates from the community-based method against the retrospective FPH for two rolling twelve-month periods. Monthly reporting by relais was high, with reports on pregnancies, births, and deaths consistently provided from all 78 relais catchment areas. Relais reported 1,660 live births and 276 under-five deaths from July, 2012 to November, 2013. The under-five mortality rate calculated from the relais data was similar to that estimated using the validation survey, where the overall ratios of the community-based to FPH-based mortality rates for the reporting periods were 100.4 (95% CI: 80.4, 120.5) and 100.8 (95% CI: 79.5, 122.0). CONCLUSIONS: On a small scale, the community-based method in Mali produced estimates of annualized under-five mortality rates that were consistent with those obtained from a FPH. The community-based method should be considered for scale-up in Mali, with appropriate measures to ensure community engagement, data quality, and cross-validation with comparable FPHs.